肾脏深度对肾动态显像测定肾小球滤过率的影响

摘要

目的 根据肾侧位显像利用核医学方法测定肾脏深度,探讨肾深度、双肾深度差对Gates法肾动态显像测定肾小球滤过率(Glomerular Filtration Rate,GFR)的影响,探究侧位显像对肾动态显像的意义.方法 收集2015年2月~12月于我院行放射性核素肾动态显像的患者118名,行肾侧位显像测量肾深度及双肾深度差(D),获得校正后的GFR与分肾GFR.Gates法默认以Tonnesen公式法估算肾脏深度并得到未校正深度GFR与分肾GFR.分析未校正及校正后的GFR与血清肌酐清除率(Creatinine Clearance Rate,Ccr)的相关性及双肾深度差对分肾功能测量的影响.结果 与肾侧位显像比较,Tonnesen公式法低估了两肾深度及双肾深度差.未校正及校正的GFR均与Ccr有很好的相关性,相关系数r分别为0.760、0.755.未校正的GFR低于校正的GFR,但无统计学差异.双肾深度差与由此产生的分肾功能变化成正相关系(r=0.98,P<0.01),随着深度差的增加,Tonnesen公式法难以准确反映分肾功能的变化.在双肾深度差较小组(D<0.5 cm)校正和未校正GFR无统计学差异;而在深度差较大的组(D≥0.5 cm)校正与未校正GFR间存在统计学差异.结论 采用肾侧位显像测量肾脏深度进行校正,可以提高Gates法测量肾GFR的准确性,特别是对双肾深度差异较大的患者,能更准确的反应分肾功能的变化.%Objective According to the kidney scintigraphy, the depth of the kidney was measured by the method of nuclear medicine. The effects of kidney depth and the difference of double kidney depth on glomerular filtration rate (GFR) measured by Gates renal dynamic imaging were explored. Investigate the significance of renal dynamic imaging. Methods 118 patients who underwent radionuclide kidney dynamic imaging from February to December 2015 were selected, and the depth of the kidney and the difference of the depth of the double kidneys (D) were measured by renal side imaging, the corrected GFR and renal GFR were obtained. The Gates method defaults the Tonnesen formula to estimate the depth of the kidney and obtains uncorrected depth GFR and renal GFR. The correlation between uncorrected and corrected GFR and creatinine clearance rate (Ccr) were anlysed, and the effect of the double renal depth difference on the renal function was measured. Results Compared with renal lateral imaging, the renal depth and the depth difference were underestimated by Tonnesen formulation. The uncorrected GFR by Tonnesen formulation and GFR corrected by renal lateral imaging were positively correlated with Ccr (r=0.760 and 0.755, respectively). The uncorrected GFR was lower than corrected GFR, but without statistical significance difference. The variant of split function estimated by renal lateral imaging compared to Tonnesen formulation was positively correlated with the depth difference (r=0.98, P<0.01), with the increase of the depth difference, Tonnesen formulation was difficult to accurately reflect the variant of split function. In the group with a smaller difference (D<0.5 cm), the uncorrected and corrected GFR had no statistically significant difference. While in the group with a larger difference (D≥0.5 cm), the two were significantly different. Conclusion Direct measurement of renal depth from renal lateral imaging can improve the accuracy of split renal GFR, especially in patients with a remarkable difference between double renal depth.